The quality of breathing during sleep varies in different people.
Everybody in the population lies somewhere on the line which is shown below.
Partners and Patients
complaints as snoring gets worse
Group 1 - "I DON’T HAVE ANY PROBLEMS WITH SLEEPING"!”
Remember when you were 18, the chances are that you went to bed at night, breathed quietly without snoring, had a very good night’s sleep and woke up in the morning refreshed and full of energy. The reason that you breathed quietly and had good quality sleep was because your airway (the passage going from the tip of your nose via your throat to your lungs) was well maintained during the night, allowing air to flow freely during breathing. This ensures that your blood is full of oxygen and your brain can settle into the deep sleep that it needs for refreshment.
However, as we age, and particularly men who put weight on with age, the airway becomes less well maintained and we start to move along the line towards the right.
Group 2 - "MY PARTNER SAYS I SNORE!"!”
When we reach Group 2, we find people who do not maintain their airway quite as well as they used to because they make a noise whilst they breathe during sleep. We call this noise ‘snoring’. Despite this, however, they breathe well and still absorb plenty of oxygen into the blood. This means that the quality of their sleep is still good and they awaken refreshed in the morning. Whilst it may be very irritating for sleeping partners and socially embarrassing for the patient it does not in itself require any medical intervention because the snorer themselves will not come to any medical harm. However, they may experience sore or dry throats on awakening in the morning. People in this group are brought along by their sleeping partner with complaints about the noise at night and are often sleeping in separate bedrooms
Group 3 - "I JUST CAN’T BE BOTHERED THESE DAYS!"!”
In Group 3 the maintenance of the airway is quite poor and not only is snoring occurring but the quality of breathing is also reduced. This means that airflow into the lungs is not as good as it should be and the muscles of breathing have to work harder to overcome the narrowed airway in the throat which is where the snoring noise is coming from. This increased work sends messages to the sleeping brain that all is not well. The brain is thus partially aroused from the deep planes of sleep required to feel refreshed in the morning. Patients come along not only because of the snoring noise but also with a new complaint - that of feeling tired during the day. This may range in the early stages from a ‘can’t be bothered’ attitude often noticed more by the family, to increasing sleepiness whilst watching television, talking to someone or at worst, driving.
Group 4 - "MY PARTNER SAYS I STOP BREATHING AT NIGHT!"!”
If you are in this group you need urgent medical attention. By now, the airway is so poorly maintained during sleep that the walls of the throat can collapse altogether and breathing totally ceases for up to a minute at a time. We term this ‘apnoea’. Not only do the muscles of breathing have to work very hard to overcome the narrowing in the throat but also during the apnoea periods the oxygen levels in the blood start to decline and the patient may look a dusky blue colour. This is very disruptive to sleep.
The brain is alerted each time the patient stops breathing and it sends messages to the muscles of the throat to unblock the obstruction.
As the patient takes his first breath at the end of the apnoeic period it is usually explosive in character and associated with movement or grunting indicating partial awakening from sleep.
It is important to realise that the sleep disruption in groups 3 and 4 is not something that patients are actually aware of - on the contrary, they think they have been asleep all night. However, they awaken very unrefreshed in the morning because the quality of their sleep has been so poor and they find it exceedingly difficult to function during the day.
Not only do they have a ‘can’t be bothered’ attitude to life but also their sleepiness can cause them to:
lose their jobs, crash their cars, and be a danger to others around them
Most of them go to sleep immediately they sit anywhere including cinemas, watching television, or sitting on a train, etc.
© 2013 East Grinstead Sleep Centre